Difficulty swallowing (dysphagia) affects approximately 18,000,000 adults and millions of children in the U.S. Dysphagia has been associated with specific diseases of aging, most commonly stroke, although we have found that disease-free aging also can affect swallowing. In the University of Wisconsin/VA Swallowing, Speech And Dining Enhancement Program (SSWAL-ADE), the age-related biomechanical and physiological changes we have documented and their impact on the flow of food beginning in the oropharynx through the gastrointestinal system explain, at least in part, the life-threatening pneumonia, malnutrition, dehydration, and reduced quality of life so frequently found in older individuals.

Another major focus of our work is to improve diagnostic imaging and treatment interventions for dysphagia. We have custom-designed barium with specific rheologic properties including viscosity, adhesiveness, and taste in order to maximize fluoroscopic diagnostic imaging and treatment information derived from the routine clinical radiographic examination. We have patented our technology through the Wisconsin Alumni Research Foundation (WARF), and an industry partner manufactures the new bariums. Our materials are becoming the clinical and research standard. Beverages that match the diagnostic fluids are currently under development to improve treatment for dysphagic patients. In addition to developing new diagnostic materials for fluoroscopic imaging, the use of (fast) magnetic resonance imaging will be explored for its utility in swallowing diagnosis in coming years.

A federally funded grant supported our work and collaboration with UW Nutritional Sciences, focusing on the effect of lingual exercise on swallowing-related outcomes including aspiration, pneumonia, tongue strength, muscle mass, swallowing physiology, swallowing-specific quality of life and diet in frail elderly patients with dysphagia. Novel anatomic MR imaging techniques were applied to oropharyngeal structures to investigate effects of interventions on sarcopenia in the head and neck. Functional magnetic resonance imaging is being applied to swallowing to elucidate central nervous system influences and neural plasticity in response to swallowing rehabilitation including oropharyngeal exercise and/or sensory stimulation, including taste. Esophageal physiology and its effect on bolus flow during swallowing are also studied. We have hypothesized that clinicians may be confusing gastroesophageal reflux (GER) with intra-esophageal reflux (IER) and intra-esophageal stasis (IES). Unlike GER, with IER food may remain in the esophagus and back up into the throat where it can be inhaled by the lungs and cause respiratory illness, particularly in many older adults. Treatment implications are tremendous and could potentially diminish pneumonia, the third leading cause of death in the geriatric population.

Finally, the U.S. Department of Agriculture (USDA) has funded our work collaborating with the Department of Food Science at the UW, determining important rheologic parameters in addition to viscosity, that are integral in improving bolus flow toward our goal of developing optimal biophysically designed fluids for people suffering from dysphagia.

Dr. Robbins is inventor on four U.S. patents administered by the Wisconsin Alumni Research Foundation (WARF) and she is the founder of Swallow Solutions, LLC.